The Return of Flu Season

“I like pigs. Dogs look up to us. Cats look down on us. Pigs treat us as equals.”

- Winston Churchill

From the British Telegraph, "The hospitals are gridlocked.” Winter flu is overwhelming hospitals in England. Four weeks of intense pressures from flu have left casualty departments (i.e. emergency rooms) “overwhelmed” with patients.  Desperately sick people have been left for hours waiting on trolleys.

"Dozens of NHS [National Health Service] units have cancelled surgery and clinics for outpatients. At least 10 major centres issued “black alerts” — the highest emergency warning — meaning they were at breaking point, forcing patients to be sent elsewhere.

Scores of hospital wards closed due to norovirus, the winter vomiting bug, which put more than 1,200 beds out of use in one week as nurses attempted to isolate the disease. "

Part of the problem is that people have no place to go after hours and on weekends.

"In many parts of the country out-of-hours services are absolutely inadequate, so what we get is people turning up at A&E [Emergency Rooms] simply because they do not know where else to go"

Bottom Line

Be prepared for a very bad flu season. In England the number of deaths from flu had almost doubled.

The return of Swine Flu

“Love is a medicine for the sickness of the world; a prescription often given, too rarely taken.” - anon

At our recent Scout Pack Meeting, one family emailed to say they could not attend – the family has Swine Flu – (now called H1N1 as our top Cub told me authoritatively.) So on this Day of the Dead (Mexico) or All Saints Day, let's consider the morbidity and mortality of Swine Flu.

Here are 8 Swine Flu Myths that could endanger your life from NewScientist.com

• The symptoms are like regular flu. You've got it if you've got a fever
  False – Up to half the people who get swine flu never got a fever. For many doctors the official line remains: if you don't have fever, you don't have flu. This is dangerously shortsighted - if you don't know you have swine flu you might miss the signs of the severe and deadly form of H1N1: shortness of breath, chest pain or blue lips.
  
• This is just mild flu. The death rates are even lower than for normal flu
  False - Swine flu is killing young people rather than the very elderly, and although winter is just starting, more young people have already died of flu than normally die over the entire winter.
  
• You're safe as long as you're healthy. Only sick, weak people get really ill
  False – see #2. The flu is killing the young and the healthy.
  
• I'll be OK if I just eat organic food, take vitamins, wear a mask, wash my hands a lot and drink plenty of fluids
  False – the article recommends vaccination
  
• The danger of over because we have a vaccine. In fact, we have several
  False – It will be months before everyone in first world countries can get the vaccine. Some poor countries may never see the vaccine in time.
  
• The vaccine isn't safe. Why take the risk to prevent mild flu?
  False – this flu packs a punch and is likely to be wide spread. The flu danger is greater than those of the vaccine.
  
• This virus won't get deadlier – it hasn’t changed much in a year
  False – random mutation is in fact “random”. There is no telling how or when a virus will change.
  
• Once this pandemic is over we'll be safe for another few decades
  False – We got lucky this time that Swine flu is not a super-bug. But an increasingly crowded world with more people with greater mobility makes it far too easy for something new to be created and spread.

Bottom Line
Swine Flu is nastier than your average flu in many ways: it kills the young, it kills the healthy, it is more resistant to heat and lasts into spring and summer. It’s nothing to sneeze at.

Bird-Pig Flu

I’m still taking the weekends off from blogging, but wanted to include a link to this scary development with Swine Flu at a turkey farm in Chile: UN warns over swine flu in birds

Bottom Line

Why is this bad? Swine flu is very contagious but not deadly (not much worse than normal flu). Bird flu is deadly but not contagious. So far the world has avoided a deadly pandemic from both.

But viruses like to exchange DNA with each other when in the same host body. In a worst-case scenario a Bird-Swine super virus could develop that is contagious and deadly.

Swine Flu Update

“My dear doctor, I’m surprised to hear you say that I am coughing very badly, because I have been practicing all night.” - John Philpot Curran

Swine flu continues to spread around the world, even to remote locations like Fuji. The World Health Organization (WHO) has raised the alert phase to level 6, pandemic. One estimate is that up to half the population could become infected. But since it is no more lethal than a common flu, most people have written if off as no big deal. But there are a few things unique about Swine flu:

• This is a new flu so your flu shot won't help. Everyone is a target. (Exception: many persons over 60 are immune. It's possible that a close cousin of this flu spread widely 60 years ago)
  
• Most flu viruses die with the heat of spring and summer. Not Swine. This flu is going strong over the summer raising problems at summer camps and other summer events like weddings.

The impact is real:

• Delta Air Lines Inc. said the H1N1 virus, also known as Swine Flu, will have a $250 million impact on its earnings this year.

Bottom Line

Continue taking flu precautions like frequent hand washing and staying clear of anyone with a cold.

When to see a Doctor?

"An apple a day keeps the doctor away” – proverb

The media has had a field day with Swine Flu and the number of health related stories is up - way up! Swedish researcher, Hans Rosling (of Gapminder.org), published a video last month comparing Google news of Swine Flu versus Tuberculosis. For each Swine Flu death there were 8176 stories published between April 24 and May 6. For each Tuberculosis death there was one tenth (0.1) of a story. So while the flu is being overhyped there is a silver lining – this is a great time to find articles on health care.

When fighting a pandemic, the best weapon is quarantine; i.e. keep away from sick people. And where are you most likely to find sick people? The Hospital! You might visit the hospital for an injury and pick up the flu in the waiting room or emergency room. I read a story today by an EMT worker who was told if they carried a person with signs of the flu, the vehicle had to be completely scrubbed and disinfected and allowed to air dry for three hours before they could pick up another patient. During a pandemic the EMS fleet would be largely grounded (at most 8 passengers a day per vehicle) if this disinfection rule were maintained. In cases of large-scale emergencies like an earthquake or hurricane, 50% of the regional hospitals may be knocked out of service when needed most.

So what happens if you need medical care during a pandemic or disaster? Many sites promote being your own doctor and stocking up now for a first rate medical supply. But do not carry this to extremes. Certainly you can do more first aid and even advanced first aid at home. Many emergency rooms visits are for minor injuries or illnesses that don’t require a doctor or for which a doctor can do nothing (You paid good money to hear, “take two aspirin and get some rest”?).

My newest commuting CD is about the history of Medicine and disc one is about Hippocrates who started modern western medicine. The instructor points out that it was not easy convincing people that natural causes, not the gods, were responsible for illness. “Faith healers”, priests of Apollo, sacrifices, etc had an excellent reputation because 90% of the time a patient will recover regardless of what is done. The human body is very resilient.

Sadly our schools don’t teach the public how to distinguish the 9 times you’ll recover on your own from the 1 time profession help is required. “Doctors cannot give set guidelines for when to see a doctor and when it is unnecessary because symptoms with the same cause vary too much and symptoms with different causes overlap too much.” [Merck] Many people play it safe and see the doctor every time or for every sniffle. When SARs hit the world in 2002-2003, there were just 208 officially reported cases in the US but the number of calls to 911 and the number of EMS runs increased by 10%. In Maryland this meant an additional 60,000 EMS calls by those who thought they might have SARS. [Based on 2002 call volume of 600,000]

Here are some sites about when to see a doctor:

About.com: Cold & Flu
Merck.com
WebMD
MyDr.com.au

Bottom Line

We can all do more to be our own doctor at home. Yet don’t over do it. Don’t bleed to death from a serious injury or attempt surgery at home because you might catch the flu in an ambulance or at the hospital. During a pandemic or disaster you will most likely need to drive yourself the hospital (ambulances and EMS being overwhelmed). And once there, the hospital staff will be overwhelmed so bring your own facemasks, water, food, and be prepared for a long wait.

Here are some sites for stocking your medicine cabinet and learning advanced first aid:

How to Maintain a Good First Aid Kit
Stocking Up on Prescription Medicines (amazing details of what to buy)
Advanced Trauma Care First Aid Kit

Wilderness First Responder
Wilderness Medicine-Beyond First Aid
Where There Is No Doctor - (html)

Why does Flu Look Like?

A severe influenza pandemic would constitute a major disaster unlike anything experienced in the modern world, where we are almost totally reliant on … ‘just in time’ delivery of food and goods … to function in our every day lives. A pandemic will disrupt every aspect of our lives, from access to health care to availability of food and water, and result in an increase in death and disease in our communities. Even our disaster assistance and recovery plans have been based on ‘mutual aid’ – a system where resources and ‘first responders’ from an unaffected area can leap into action to help people in the area of an earthquake, hurricane, or terror attack. But in a pandemic, no such unaffected areas are likely to exist. You now understand that it is up to each individual to care for him- or herself and loved ones. – from the InSTEDD Pandemic Influenza Citizen’s Guide

Yesterday I gave some of the background on the origin of InSTEDD and its Citizen’s Guide to Pandemic Influenza. Today I’d like to include other interesting facts from the guide.

What does the seasonal flu look like?

Normal influenza can encompass any or all of the following symptoms:
• Begins abruptly
• Symptoms include fever, chills, body aches, loss of appetite, headache, and fatigue
• Fever (>100.4ºF) – usually lasts 2-3 days
• Respiratory tract symptoms include cough without phlegm, sore throat, and congestion
• Temperature greater than 100.4 ºF
• Stomach and intestinal issues, such as diarrhea, nausea, and vomiting.

Pandemic flu may look very different from seasonal flu symptoms
• Sluggishness or alterations in mental state (seen most often in the elderly and infants)
• The 1918 Spanish strain was unusual for killing many young adults and otherwise
healthy people. People were sometimes struck suddenly with illness and within hours were too feeble to walk; many died the next day. Symptoms included a blue tint to the face (due to
insufficient oxygen from lungs filled with fluid) and coughing up blood.

Children and adults may develop sinus problems and ear infections from the flu. In rare cases complications from bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes may be fatal.

Bottom Line
According to the Center for Disease Control, CDC, “It is very difficult to distinguish the flu from other infections on the basis of symptoms alone. A doctor's exam may be needed to tell whether you have developed the flu.” Healthy adults may be able to infect others 1 day before getting symptoms and up to 5 days after getting sick. Therefore, it is possible to give someone the flu before you know you are sick as well as while you are sick.

The InSTEDD guide recommends seeing a doctor immediately if you experience any of the following symptoms:

Adults & Children
• Blue discoloration skin, lips or nail beds
• Coughing up blood or foul-smelling sputum
• Bleeding from nose that cannot be stopped easily through pressure
• Bloody diarrhea
• Chest pain
• Difficulty or pain in breathing
• Shortness of breath when at rest
• Persistent vomiting or severe diarrhea not managed by standard measures
• Symptoms of severe dehydration, e.g., a significant reduction in urine output
• High fever for 3 or more days without improvement
• Sudden high fever with recurrence of symptoms
• Extreme drowsiness and difficulty waking
• Disorientation or confusion
• Seizures
• Severe earache
• A severe change in the ability to function, especially if elderly
• Flu-like symptoms with a pre-existing chronic condition like heart failure, asthma or diabetes
• Flu-like symptoms while under immuno-suppressive therapy

Additional Symptoms to Watch for in Children
• Flu-like symptoms or fever in any child less than 3-months old
• Flu-like symptoms with child taking aspirin regularly (could be Reye's Syndrome)
• Excessive irritability or listlessness
• Has a full or sunken fontanel (soft area on the top of a young child’s head)
• Is limp or unable to move

Impact of a flu pandemic

"I wish that you would help build a global system to detect each new disease or disaster as quickly as it emerges or occurs." – Larry Brilliant’s TED Prize wish

One of my favorite web sites is TED.com, “Ideas worth spreading”. TED stands for “Technology, Entertainment, Design” and holds an annual conference where fifty of the most creative minds in the world are given a brief chance (18 minutes) to present their beliefs or works. Over 400 of these talks can be freely viewed at TED.com.

In addition, each year three “exceptional individuals” are awared a TED Prize of $100,000 plus "One Wish to Change the World." Each recipient presents their World Changing Wish at the conference and TED helps organize companies and participants to bring the wish to life. For example, the 2006 TED Prize winner, Larry Brilliant, wished to build a global system for early disease and disaster detection.

Larry was one of the team leaders from WHO that helped eradicate Smallpox from the world. In response to his wish, Google donated $14 million to Larry and five other organizations trying to prevent pandemics. With his TED Prize and Google money, Larry created, InSTEDD, to serve as a free data collection and information organization for the current status of and best response to global infectious diseases. Whereas WHO collects data only from official (i.e slow) government sources, InsTEDD searches the Internet for live outbreaks of disease. The first hint of an outbreak may reveal itself with a spike in Google searches in a region for headaches, nausea, bleeding, etc.

Bottom Line

Everything above was a long introduction to the ideas I really wanted to present. In 2007 InSTEDD published a booklet called, Pandemic Influenza, Preparation and Response: A Citizen’s Guide which I recommend reading. It was updated this month to include Swine flu.

Here is what the guide says about the impact of a flu pandemic.

Communities will be affected simultaneously
• At least 30% of the overall population may become infected in a severe pandemic
• Absenteeism could be upward of 50% in a severe pandemic
• A pandemic is likely to last for 12 to 18 months
• Communities could be affected by several waves lasting 6 to 8 weeks each
• Vaccines and antiviral drugs for pandemic influenza will be in short supply, may be of limited effectiveness, and will likely not be available to most communities
• Most of the ill may wish to seek medical care [BUT ] All healthcare systems will be overwhelmed
• Health facilities … may be inadvisable to enter owing to increased chances of exposure to the virus
• People and communities will likely be on their own without the help of mutual aid from other communities, hospitals, or other public services

Routine services may be disrupted
• Hospitals, schools, government offices, and the post office may be disrupted
• Telephone service, the Internet, commercial radio and TV broadcasts could also be interrupted if the electric power grid falters or fails
• Stores and businesses may be closed and/or will have limited supplies
• Local ATMs and banks may be shut down, and cash will be in short supply
• Public transportation services and communication may be disrupted
• Gasoline supplies may be limited or unavailable
• Travel could be restricted by fear, quarantine or curfew
• Public gatherings may be canceled

Note that there is nothing said here about dying. If you’ve had a bad case of flu you’ll recall that you were sick as a dog for days and unable to work or do much of anything. Even a non-lethal flu can bring a country to its knees if enough people are sick. A pandemic means widespread sickness, not necessarily widespread death. (Altough at times I wised I was dead the last time I had the flu. Ugh!)

UPDATE on Swine Flu:
A new study suggests that Swine flu has a basic reproductive rate between 2.2 and 3.1 others. This means that every sick person will on average infect 2 or 3 other people. Normal flu has a rate of 1.2 and the Spanish flu of 1918 had a rate of 2-3. (Interestingly measles has a rate of 12-18! Very infectious!)
The death rate for Swine flu is now estimated at 0.4%. The Spanish flu US death rate was 0.64% but as high as 2.0% worldwide.

For the US we are not talking about huge differences here. By my calculation, Swine flu is equally as contagious and two-thirds as deadly as the great 1918 pandemic in America. This does not make it “safe”. And yet nations are asking WHO to downgrade the alert, Scale for Flu Warnings Overly Simplistic, Countries Tell WHO.

UPDATE 2
Some Elderly Immune to Swine Flu? It seems that a close variant of this flu may have spread in the early half of the 20th century. Many seniors have antibodies to Swine Flu by surviving it decades ago.

False Alert with Swine Flu?

“With Mexico saying the worst may be over and the new H1N1 virus starting to look more like a seasonal flu strain in the United States and elsewhere, critics are going to start asking if public health officials overreacted to the outbreak.” – Reuters news

Again I hate to bash the media but it seems that most TV/Radio/Newspaper coverage has only two modes: “full coverage emergency” and “not worth discussing”. In just over a week swine flu has gone from “The End of the World as We Know It” to “never mind, just a normal flu, nothing to worry about”.

The truth lies somewhere in the middle.

Was this a false alert like the Swine Flu of 1976?
No. The President Ford swine flu was found on one military base in NJ and did not spread. In contrast, the swine flu of 2009 is very contagious. Thousands of cases in Mexico and within a few weeks it had spread to over a dozen countries around the world. The World Health Organization rightly classified this as phase 5 (Pandemic Imminent).

Is this swine flu dangerous?
Yes. One thing I’ve learned from this emergency “drill” is that “normal” flu is dangerous. How did it happen that 2000 yearly flu deaths in NYC and 36,000 deaths annually in the US are considered “normal”? Consider the mothers protesting against the Iraq War and the deaths of their sons. In six years since 2003 the numbers of US casualties has been 4284. During the same period there were 216,000 flu deaths, 50 times the number of soldiers killed. Why don’t we see mothers protesting for better flu drugs?

Was it wrong to close schools, etc?
No. Consider the game of Russian roulette. Is it safe because 5 times out of six, nothing happens? When this flu appeared it spread fast and its potential was unknown. Suppose we treated it as “normal” and allowed it to spread and THEN discovered it was a killer. By that point the horse is out of the barn and there is no going back. The right time to stop a potential pandemic is at the beginning.

Is this swine flu just a “normal” flu?
Unknown. The death toll in Mexico was overstated with many sicknesses related deaths misclassified as swine flu. Scientists now think this is NOT a “killer” flu but it may be stronger than your average flu. The medical studies are still being done to exactly classify this flu strain.

Won’t my flu shot protect me? What about the drug Tamiflu?
No. Flu shots work by giving you a small sample of dead flu viruses so your body can learn the shape and create antibodies before the live virus invades. The Mexican swine flu is a new variant that no one is yet protected against. There are also some reports from Mexico of doctors & nurses who had taken Tamiflu but still caught the flu. For swine flu Tamiflu may be better at relieving symptoms than in prevention.

Bottom Line

Is the danger over?
As stated in the article, Scientists dig for lessons from past pandemics, “In each of the four major pandemics since 1889, a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. This was true in 1889, 1957, 1968 and in the catastrophic flu outbreak of 1918”.

Flu viruses are constantly evolving and changing – hence the need for a new flu shot each year. A global killer virus needs two things – the ability to spread and the ability to kill. The current swine flu shows it has the ability to spread quickly. As thousands or millions or even billions of people become infected, the likelihood of mutations increase. Most mutations will be harmless. But it takes just one bad roll of the cosmic dice to change swine flu into a deadly & contagious virus. We can hope this won’t happen but we should prepare now in case it does.

WHO can you trust?

Then I'll get on my knees and pray
We don't get fooled again
Don't get fooled again
- lyrics by The Who

The flurry of stories over Swine Flu has certainly been educational; almost like a global safety drill with a chance to evaluate the key players. There has been a wide range of public and official reactions from “head to the hills” to “nothing to worry about”. So whom can you trust?

Many studies have shown that people are a poor judge at putting risks into proper perspective. My current commuting book on CD, “Predictably Irrational”, details the many ways people are wired to act in ways that defy “rational” behavior. For example, use the word “free” and people will mob and sometimes riot to get something they don’t really need. When it comes to diseases, the word “death” triggers similar irrational behavior.

Yesterday it was announced that the first person (an infant) had died of Swine Flu in the US. Panic!!!! Well, no. Since the majority of US cases are in New York City (Queens), mayor Bloomberg held a press conference and told the public that 2000 New Yorkers die every year from flu. Death from flu is normal and part of everyday life that no one usually thinks twice about.

So why the hyper-reaction over Swine Flu?

• We are past the normal flu season so deaths from this strain stand out as unusual.
• The media has given it a name and made it their top story for ratings.
• This flu (Mexico only so far) has killed healthy adults. This is serious news and makes this strain different than “normal flu”.

Once reliable source for judging the danger of influenza is the World Health Organization (WHO). They publish a global risk level for a pandemic (from all known flues) on a scale of 1 to 6.
Phases 1-3 represent flu in animals (like Bird Flu) that spread poorly to people.
Phase 4 means there is verified human-to-human transmission of an influenza virus able to cause “community-level outbreaks.” There is a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least two countries. Declaration of Phase 5 is a strong signal that a pandemic is imminent.
Phase 6 means the disease is a pandemic affecting many countries.

Bottom Line
On April 28 WHO raised the pandemic risk level from 3 to 4. On April 29 the threat level was raised to 5. WHO advises preparing for a pandemic but oddly does not yet recommend closing boarders or canceling travel plans. Personally I think that is under-responding and favoring the interests of business over people. So far most US cases have been traced back to someone visiting Mexico so it seems prudent to stay away until the flu is under control. Why visit a country that has declared itself a National Health Emergency?

Prepare, take precautions, and odds are you'll be OK. During the Spanish Flu of 1918 40 million people died which sounds like a lot. But 73% of Canadians and Americans NEVER contracted the Spanish flu. 97.5% of those who were infected, managed to survive and recover. With modern medicine the rate of surviving is higher today. WHO estimates that a modern pandemic would kill 5 million globally instead of 40-50 million.

Proper Ways to Handle Swine Flu

“Panic is quite rare. What's quite common is denial; denial is why panic is rare. We are organized such that, when we're about to panic, we trip a circuit breaker instead and go into denial.” - Peter Sandman, Risk Communication Specialist

My column yesterday could be viewed as a form of denial. I suggested ignoring the media-hype and twitter panic on swine flu and calming preparing for a possible pandemic that was unlikely to happen. Since then I’ve done more reading from the opposing view point of “don’t risk your life, respond now.”

The NYT Health section this week includes a well-written article on Assessing the Danger of New Flu. It discusses the complications in judging how dangerous flu might be and then looks at Hong Kong as a model for proper government response.

Contagion and virulence
Two measurements describe flu or any disease. Contagion = how easily does the disease spread from person to person? Virulence = how deadly is it? (i.e. what percentage of people die from catching the disease?)
- The Spanish influenza of 1918 had a mortality rate of ONLY 2.5% but was very contagious and killed tens of millions.
- Bird Flu (global/current) kills 61% of those afflicted but so far infects mostly birds, rarely people. The total number of fatalities is 257.
- SARS (Hong Kong 2003) was virulent (17%) and spreadable. But it killed only 299.
It is not easy to figure out which flu bugs will be pandemics and which ones won’t before it is too late.

Lessons Learned
Hong Kong (HK) learned much from SARS about how to respond to an epidemic:
- By weeks end, HK will have six laboratories studying the genetic markers for Swine Flu to allow for rapid detection and diagnosis of new cases
- HK has tens of thousands of doctors and nurses, including retirees, on standby and ready to be mobilized. (The US has a similar program called the Medical Reserve Corps created under President Bush.)
- HK has contingency plans to keep public transport, electricity, food supplies, telecommunications and other vital services running if large numbers of people fall ill.
- Since SARS Hong Kong has added 1,400 respiratory isolation unit beds to hospitals.
- HK with a population of seven million people has stockpiled 20 million treatment courses of Tamiflu. The US with 300 million people has 50 million courses of Tamiflu.
- HK is quickly passing a law to require all health professionals to notify authorities of any suspected cases of Swine Flu. This allows the disease to be accurately tracked.
- HK has broad and detailed legal powers to quarantine possible cases. The US (after six years) is still debating how to handle legal issues during a possible pandemic.

Bottom Line
Several articles today have suggested that a little panic is good for public health. As discussed above it is very hard to know which flu bugs will fade quickly and which ones will be deadly killers. By the time authorities do know, the bug may have already spread widely making quarantines useless. The safest course for individuals and the public is to follow the example set in Mexico at the first hint of a new flu virus. Order the public to stay home and close the schools, non-essential business and all public events. If you must go out, wear a facemask.

Staying home and sitting out the flu will save lives but at terrible economic cost in lost business, lost jobs, etc. While you and I may value our life over money, not so for governments which feed on tax revenues. Since governments exist to prevent panic and to promote business, they will placate, lie, under report illnesses & deaths, over promote actions & cures, etc, to keep the peace. So Mexico deserves credit for putting the people first by declaring a National Emergency and quarantine.

Updates
WHO Raises Swine Flu Alert Level but stopped short of declaring a global emergency.
The suspected number of deaths rose to 149 in Mexico, the epicenter of the outbreak with nearly 2,000 people believed to be infected. The number of U.S. cases rose to 48, the result of further testing at a New York City school, although none was fatal.

Swine Flu

How quickly can Swine Flu make you sick? About 90 minutes of CNN should do it. -American Digest

There is nothing better for a news company than FEAR. When they can sell the idea of "Watch our news or you might die", ratings improve and they make money. Too bad if the alarm was false or too extreme and you ended up wasting your time and your money.

Last night I was watching some conference talks from TED.com online. (Highly recommended!) One speaker from Africa described how his team put together a text messaging emergency alert system to cover riots, government-police actions, etc. It worked very well. In fact too well. The amount of public created "emergency" traffic from tweet and texting far exceeded the ability of responders to read it. In version 2 of the system they had to install ratings to judge the accuracy and reliability of senders to separate the wheat from the chaff.

Now Swine Flu is real and it is back. It is not yet a pandemic but people are acting as if it were. AmericanDigest.org shows how The Virus Does Not Travel at the Speed of Tweet, But the Tweet of the Virus Does. Panicked Tweeters were publishing "breaking news" from the CDC (Center of Disease Control) claiming that the virus was spreading and "could not be contained." USA Today reports Swine flu spreads panic in Mexico City. With 81 possible deaths in all of Mexico since April 13, health officials ordered some 500 cultural and sporting events cancelled. According to Bloomberg.com, the Mexican President declared an emergency April 25 and canceled school at all levels in Mexico City and the state of Mexico until further notice.

Precaution and preparation is important - for example Mexicans are urged to wear face masks in public. But keep a sense of perspective. In the US (2001 data) 2525 people died every day from heart attacks and 120 died every day from auto accidents. Why don't we see panics and government emergencies over butter and cars as agents of death? Every year the CDC estimates that 36,000 people in America die of "normal" flu but people still refuse to get "normal" flu shots. Blogger Ryan Sager writes

Our brains are pretty bad at assessing risk — we worry about flying (which is safe), while we love driving (which kills far more people); we worry about terrorism (which kills virtually no one), while we die of heart disease (No. 1 killer in the United States) — and so we vastly overestimate the chances that we, personally, might get swine flu.

In the article, Risk Communication Before and During Epidemics the author notes that there is a very low correlation between risk/harm and outrage/perceived risk.

Whatever your measure of harm, across a wide range of risks, the correlation between how much harm [a risk is] going to do and how upset people are going to get is this absurdly low 0.2 correlation.

Swine flu may get worse but right now driving your car is 40 to 100 times more deadly.

Bottom Line
Swine flu is serious but the 20 known cases in the US appear to be a mild strain. Watch the blogs and Internet for news but filter it for truth vs bias and rumors. Prepare but don't panic. If you have flu symptoms see a doctor and get tested for Swine flu, don't go to work or school and share the virus with others. Avoid people who are coughing or sneezing and wash your hand frequently. If you are very concerned: avoid crowds or wear a face mask (very common on Japan!)

Don't rely totally on the US government for information (and never rely on evening news casts). Governments will under AND over react. The Washington Post reports that U.S. public health officials did not know about a growing outbreak of swine flu in Mexico until nearly a week after that country started invoking protective measures, and didn't learn that the deaths were caused by a rare strain of the influenza until after Canadian officials did. (This despite our huge Department of Homeland Security!) Now with 20 mild cases of Swine flu in NY and CA and TX the US Department of Health declared "a public health emergency" on April 26. According to Homeland Security Secretary Janet Napilotano, the emergency declaration is standard operating procedure and enables 12 million doses of the drug Tamiflu to be distributed from Federal stockpiles to states that need to deal with a flu outbreak. The terminology here is terrible! An "emergency declaration" is standard operating procedure? What will the goverment call a real pandemic and crisis?

Update

US government claims it is prepared to handle Swine Flu despite the fact that after Obama's first 100 days we have no Surgeon General, no Secretary of Health and Human Services, and no appointees in any of the department’s 19 key posts.

NYT Story - To quarantine or not? Lesson from the 1918 Spanish Flu Pandemic

Resources
The CDC Swine Flu website is www.cdc.gov/swineflu/swineflu_you.htm
CDC Health Advisory, April 25, http://www.cdc.gov/swineflu/pdf/HAN_042509.pdf
CDC Travel Advisories: http://wwwn.cdc.gov/travel/notices.aspx
World Health Organization (WHO) Epidemic News: http://www.who.int/csr/don/en/
Health Map: http://healthmap.org/en
Swine Flu News: http://health.einnews.com/news/swine-flu

Google Alerts: create an email alert of "Swine Flu" news as soon as it hits the internet.
Amazon has a site for a Bird Flu survival kit www.amazon.com/Bird-Flu-Survival-Kit-Basic/lm/RWDK3B57W2U2Q/